Healthcare Technology Featured Article

October 05, 2016

Using Health Information Technology to Improve Patient Engagement

Patient engagement has been on a lot of lips the past few years but has mostly been given lip service. While “patient engagement” solutions are increasing and expected to reach $34 billion in 2023, they have been met with tepid response from both providers and consumers — despite their promise to reduce costs and improve outcomes. Part of the challenge is that the glitz of the technology is obscuring a very simple truth: patient engagement is really about connecting the right people at the appropriate moments. While we are still early in the consumer health information technology (health IT) life cycle, how can we use it to more actively engage patients? How can health IT improve their experiences and outcomes across the continuum of care?

Drivers for change. The need for taking patient engagement to the next level comes at an interesting convergence of legislation, patient demand, payment mechanisms and technological innovation. Drivers for change include:

  • Legislation. Patient engagement is a necessity for providers and vendors because of two laws.  The first, meaningful use (MU), required providers to provide a means for patients to access their health information, which meant that vendor offerings had to comply within certain time frames. Now patient engagement is a mandatory part of MIPS, the Merit-Based Incentive Payment System. Both programs were created to help spur adoption of health IT, cut costs, and improve quality of care and patient outcomes. Patient engagement is viewed as a key piece of those objectives and is one in its own right.
  • On-demand, online society. Patients are beginning to demand more personalized care and access to information from their providers. After all, consumerization is now a given in daily life. Patients wonder why health care providers can’t leverage technology and change their culture to be more like banks (online 24/7 for multiple products and transactions), transportation (Uber and Lyft come to mind), retailing (think Amazon and PeaPod) and travel (such as Groupon, Expedia and even airlines).  
  • Access to data. There is a growing demand for access to patient data. A recent survey found that most people – 87 percent – said they want to control their health data. This demand for data access is growing among both patients and their caregivers. The latter group is varied and large, as well as increasingly vocal about their need to access patient data. According to estimates, some 65.7 million Americans (or 29 percent of adults, involving 31 percent of households) serve as family caregivers for an ill or disabled relative. That’s not to mention the 5.7 million grandparents who are responsible for the lives and health care of their live-in grandchildren.
  • Move toward value-based reimbursement. Compared with the rest of the world, the United States spends more on health care but has worse outcomes, according to a report from the Commonwealth Fund. That is among the reasons why there has been a move toward value-based reimbursement in both the public and private sectors. Patient engagement is viewed as a way to enhance the cost-outcome equation. In fact, there is some evidence to suggest that engaged patients experience better health outcomes at lower costs than other patients. As a result, such value-based organizations as accountable care organizations are moving (albeit slowly) toward engaging patients across the continuum of care. They are also beginning to use patient engagement in quality performance and payment metrics.
  • Technology. The health IT sector is hot for venture capitalists who are investing big time in technologies related to patient engagement. A recent analysis showed the top health IT investment trends in the second quarter of 2016 were related to patient engagement: mobile health ($779 million), data analytics ($234 million), wearable sensors ($129 million), mobile wireless ($75 million) and wellness ($60 million). Resulting disruptive innovations should create cheaper, faster and more efficient ways in which providers can engage patients — and vice versa.

Barriers. On the face of it, patient engagement sounds appealing and simple as a concept. As always, the devil is in the details. Barriers to adoption include:

  • Costs. Providers are struggling to implement MU, make electronic health records (EHRs) a part of their work flows and realize a return on investment. Most haven’t even begun to consider the requirements for MIPS. There are considerable upfront and additional costs inherent in changing over to a patient-centric focus and purchasing the technologies needed to engage patients. However, incentive payments for such activities have dried up and many practices’ IT budgets already are maxed out. Business cases are still emerging. 
  • Vendor offerings. For vendors, patient engagement is another chicken-and-egg proposition: if there is demand, they will build to it. Even in the face of mandatory legislative requirements like MU, vendors will not proactively embrace patient engagement unless providers do as well. So far, that hasn’t happened. Patient engagement seems to be near the bottom of everyone’s to-do list.
  • Technology gaps and usability. There’s patient engagement technology all over the place but adoption is slow. Most providers use portals tethered to EHRs to connect with patients. However, uptake by both groups and patients still is limited. There’s no shortage of gimmicky “patient engagement” tools (think Fitbit), but many don’t offer any clinically valuable information to providers. The problem may not be the technology so much as usability and value. What’s missing is a patient engagement tool that gives providers a very specific purpose that is recognized as valuable both by the patient and the provider and which enables the provider to take proactive action when necessary without having to wade through reams of data. In other words, the technology must make the patient-initiated data actionable.

Six trends to take patient engagement to the next level:

1. Data analytics. The rise of new reimbursement models and the massive amount of clinical data contained in EHRs will create a need for data analytics. This structured approach will be essential in helping providers manage patient populations and zero in on individual patients at risk. This will help providers meet their cost and quality targets. At the same time, analyses will help form the backbone of targeted patient engagement strategies. 

2. Improved access to patient data. As mentioned previously, demand is growing for access to patient data. Stakeholders are beginning to respond. In the private sector, for example, the CommonWell Health Alliance recently announced that eight EHR and portal developers will enable patients at their provider clients to access their health data, allowing them to self-enroll in the network, link their health records from different care providers and view their data across the network. On the public side, the federal Office of the National Coordinator for Health Information Technology (ONC) has been proactive in helping patients gain better online access to their health records. For example, the agency garnered pledges in February from hospital systems and health IT developers to improve consumer access to health records and not block access to data. The latter has been viewed as a problem in the marketplace. All health care organizations pledged to share patient records. ONC hopes for a progress check in the next few months.

3.  Longitudinal view of patient care. Organizations are moving away from the “one doc, one patient, one disease” model to a world of shared decision making and a longitudinal view of patient care. Health IT and patient engagement will be key to connecting the dots along the continuum of care.

4.  Rise of consumerism. Expect to see more consumerism in health care. In fact, one organization called 2016 the year of consumerism. Providers are now reorienting toward patients as consumers and emphasizing their connections with community. There are several reasons for this trend. First, providers are taking to heart consumers’ demands for convenience and value because they improve care and outcomes. Those are, after all, mission-critical objectives for everyone. Second, they are responding to payers’ new reimbursement models linking payments to quality and patient satisfaction. Third, the patient experience has value and can create competitive advantage. Finally, patients, themselves, are seeking value for their health care dollar, especially now that millions are purchasing their own insurance and experiencing high — and escalating — out-of-pocket costs. These costs were masked when insurance was more of an employer-paid benefit.

5. Demand for connectedness. Consumers are demanding to stay connected with everyone, everywhere, anytime — with technologies customized to their needs and pocketbooks. We must not fall into the trap of thinking that solving the patient engagement problem is all about technology. It’s also about meeting consumer expectations of getting and staying connected in an increasingly connected world. Uber is a good, well-known analogy. The company has invested in a lot of technology, but at the end of the day the valuable piece is connecting one person with another at just the right time. The same principle holds true in health care, for which the useful tools and interesting business models will be about connecting patients and providers at the right moments.

6. Impact of demographics and technology diffusion. Adoption of patient engagement tools will be impacted by demographics and the normal speed of technology diffusion within a market, which generally takes 10 to 15 years. We are still very early in the availability of consumer health care technology, including patient engagement tools. That means there is room for the market to grow and mature. At the same time, the oldest members of the “Gen Z” generation are beginning to have children, and this generation demands technology to stay connected and engaged. As a result, demographics will move the needle for patient engagement in the long run. Taken together, demographics and technology diffusion will create a sizeable patient engagement market in the future. Estimating the size of the market may be challenging, however. For one thing, there is no single definition of patient engagement, which often is used synonymously with population health. They are related but different: patient engagement is an important piece of population health. That’s one reason why the patient engagement market may be underestimated. One analysis puts this at $34 billion in 2023 or only around $100 per person in the US but some industry experts think that number is too low and the market potential is considerably greater.

There’s no doubt about it. Increased patient engagement facilitated by health IT will continue to change the ways patients and providers interact. 

Edited by Alicia Young
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